Young Athletes and Hot Weather: Reducing the Risks of Playing Sports

There’s a lot more awareness these days of the dangers of concussion for athletes young and old, but for kids who play sports, head trauma is fairly rare compared with other preventable risks.

As a story last year in the New York Times pointed out, the No. 1 killer of young athletes is sudden cardiac arrest. Usually, a child’s heart stops because of a pre-existing condition that could have been detected but wasn’t.

Another potentially lethal event an active kid can experience is heat stroke. It’s not related to health status and is completely preventable.

These two life-threatening conditions are more likely to occur during summer. This month, we review what they are and how to recognize, treat and prevent them.

Stopped Heart (Cardiac Arrest)

Cardiac arrest is when the heart stops suddenly, along with breathing and consciousness. According to The Times, it is exceedingly rare for a blow to the head to result in death. “In contrast, a young athlete dies from a cardiac incident once every three days in the United States….”

One mother interviewed by the paper put a stark perspective on this reality. Laura Friend’s 12-year-old daughter Sarah died of sudden cardiac arrest in 2004 while she was swimming. “When your heart fails from something that could have been treated — which happens all the time — you don’t have another chance. As someone told me, sudden cardiac arrest is not rare; surviving it is.”

Why aren’t more people aware of this danger, and what to do to prevent it?

One reason is because members of the medical community disagree about the best course of action for reducing deaths through suitable precautionary measures for young athletes.

Kids in the U.S. invariably must pass a physical exam before they’re allowed to participate in organized sports. The exam includes listening to the heart, checking blood pressure and reviewing family medical history. If nothing raises concern from that review, usually additional testing is not recommended or done.

Some doctors believe administering an electrocardiogram (EKG or ECG) should be included in the routine screening exam. It’s a noninvasive test in which 12 electrodes are taped to the chest to record a couple of seconds of heart activity on a graph. Advocates for EKG say it would detect about 2 in 3 of the hidden heart problems that can be fatal if aggravated by exertion, especially in competition.

Sudden cardiac arrest in a young athlete most often occurs because of a structural heart defect or a problem with the heart’s electrical circuitry that generally is not captured during a routine physical. The most common defect is hypertrophic cardiomyopathy (HCM), or thickening of the heart muscle. The condition has few warning signs. You might remember collegiate basketball player Hank Gathers, who collapsed on the court during a game and died of HCM.

An EKG screening would cost $25 to $150, and might not be covered by insurance. Some school districts have agreements with local providers to test their athletes at discounted rates. Colleges often screen all athletes.

But EKGs, like other screening procedures, can render false alarms or false positives. That’s why many medical authorities are skeptical about their widespread use. When a test is positive, it prompts more testing, which can be not only expensive, but uncomfortable and invite complications.

Many safety advocates believe that universal EKG screening might excuse team officials and from being prepared; they believe having lifesaving automatic external defibrillators (AEDs), which restore heart rhythm with an electrical current, should be standard equipment in every school, playing field and gymnasium. And that CPR should be a required skill for staff. Most athletic trainers, of course, do know CPR.

Instead of spending money on EKG screenings, these folks say, school districts should devote those resources to hiring trainers and medical staff who know how to respond to these emergencies, and how to use the equipment.

Properly used, an AED, according to The Times, can boost the survival rate after sudden cardiac arrest by at least 60%, but fewer than 1 in 3 U.S. schools has one.

A few years ago, a 17-year-old football player’s heart stopped during a game, even though he had not been involved in contact on the previous play.

The high school’s athletic trainer immediately performed CPR and shocked his heart with an AED three times until it resumed beating. He was found to have had an undiagnosed heart condition. He had a defibrillator implanted in his chest, and although he no longer plays football, he’s a fully functioning, successful student.

Should your child have an EKG before participating in sports?

“Let the parents decide,” said Friend. A founder of Parent Heart Watch, a national organization committed to preventing sudden cardiac arrest in children, she’s a strong believer in the test. “No one told me that I could have paid $50 or $100 for a test that would have detected a fatal heart condition in my daughter. I would have paid for that.”

You might make a different decision. But you shouldn’t do so without ensuring that the sports programs in which your children participate are run by people training in recognizing and treating a cardiac problem, and have the tools to do so.

To learn more, see our blog, “Children Whose Hearts Stop,” which reported that, by some estimates, there might be warning signs in as many as half of all cases of sudden cardiac arrest in children.

Heat Stroke

During the hottest months, according to The Times story, heat stroke causes one young athlete to die about every other day.

A heat stroke victim has a high temperature and often loses consciousness when the internal temperature-regulating mechanism fails when exposed to excessive air temperatures. Body temperature rises during exertion, so physical activity in hot weather is a risk factor. Humidity is an added risk factor.

Another sad story was told to The Times by Rhonda Fincher. Her son, Kendrick, died in 1995 from heat stroke he suffered during an early season football practice. “When my son died, people treated it as a freak thing. The ignorance was unacceptable because, unfortunately, it is not infrequent. And we should all know that.

“No healthy child should be sent off to a routine practice and die from it.”

Making sure that doesn’t happen is all about changing the outmoded and dangerous perception that the best way to get athletes in shape during the preseason is by punishing workouts, such as football’s notorious “two-a-days.” Thankfully, more enlightened attitudes are becoming the norm.

Our tolerance to hot weather, it seems, has declined as our standard of living has improved.

Modern athletes are used to comfortable environments most of the time. In summer, they live in air-conditioned buildings. If they want to run and it’s too hot outside, they can hit the treadmill at a climate-controlled gym. Few school-age children have strenuous, outdoor jobs, as they might have a couple of generations ago. As The Times notes, “These lifestyle changes make modern athletes less likely to be ready for the heat of an outdoor practice.”

Depriving athletes of water no longer is seen as building character and endurance, but stupidity.

These days, the National Collegiate Athletic Association (NCAA) imposes strict guidelines on the first few days of preseason football practices. It restricts the amount of equipment the players may wear for a couple of days. And the National Football League (NFL) has adopted similar acclimation standards, especially in the aftermath of the death of Korey Stringer, an offensive tackle who died in 2001 of heat stroke during a preseason practice for the Minnesota Vikings.

In the 10+ years since the NCAA imposed its restrictions, the number of heat stroke deaths at college football practices has plummeted, “But without a national governing body for high school athletics,” says The Times, “attaining comparable guidelines for heat stroke has been a state-by-state fight.”

In states that do have those restrictions, heat stroke deaths have declined significantly. Parents of high school athletes should ensure that the hot-weather workout policy recognizes the need for acclimation.

Preventing heat stroke is low-tech and inexpensive. Often, it’s preceded by cramps, and always by heat exhaustion, marked by heavy sweating and a rapid pulse, the result of a body overheating. Jocks exhibiting these symptoms can be immersed in a tub of ice water. It’s that simple. The sooner you lower the body’s temperature, the quicker the threat abates.

But youth sports safety advocates often say that cost or convenience is not the main issue in diminishing risks to athletes. They say that educating players about the signs of overheating and the necessity of seeking help are key. So make sure your young athlete knows the signs, and whom to tell if he or she has them.

To learn more, see our blog, “More Cautions on Kids Locked in Hot Cars,” which warns about the dangers of children being trapped in hot cars, whether by their own playfulness, or their caregivers’ inattention.

How to Chill the Risks of Hot Weather

Before your child participates in school sports, find out if the department has a working AED, and requires teams to ensure it’s present during practice and games. Confirm that the coaches and/or training staff know CPR and how to use the defibrillator.

Visit Parent Heart Watch, the state-by-state network of parents and partners dedicated to minimizing the incidence and effects of sudden cardiac arrest in youth.

Be mindful that it advocates EKG screening, which might not be your choice after you review information about the test’s risks of false positive. One research paper showed that when screening high school athletes for heart abnormalities, EKGs had a lower false-alarm rate than a history and physical examination.

Still, the researcher said that he wouldn’t change the recommendations from the American Heart Association (AHA) that a history and physical exam should occur before someone participates in sports, and that an EKG usually isn’t justified. He believes the guidelines for who should get one must be refined. Read the summary on MedPageToday.com, and the AHA guidelines here.

Apart from exercising common sense to prevent heat illness, and teaching your kids about the warning signs, visit SafeKids.org to learn how staying hydrated during physical activity lowers the chances of overheating.

Here’s to a healthy 2014!

Sincerely,

Patrick Malone
Patrick Malone & Associates

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